I want to leave EM and open a ketamine/wellness clinic

[funnybanana]

Looking for advice here. In short, couple years out of residency and hate it. I have zero debt and want to leave this specialty for good. It’s not the actual emergency care—which I think most of us love— but all the other bull**** that comes with it.

I have great bedside manner. I am hard working and feel that I can better use my talents starting my own business.

To any of those who have started a ketamine clinic, can you offer any insight on how to get started?

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[RustedFox]

Jeez.
Not a thought given to "is this the right thing to do", huh?

Ketamine for all!

Mom doesn't want to mom because it's not all Instagram moments and live-laugh-love? Ketamine.

Mad at your coworkers? Ketamine.

Bummed because your sportsball team lost? Ketamine.

That's the business model. No, I'm not going to buy it that you're out there providing a critically overlooked psychiatric need.

 

[funnybanana]

Jeez.
Not a thought given to "is this the right thing to do", huh?

Ketamine for all!

Mom doesn't want to mom because it's not all Instagram moments and live-laugh-love? Ketamine.

Mad at your coworkers? Ketamine.

Bummed because your sportsball team lost? Ketamine.

That's the business model. No, I'm not going to buy it that you're out there providing a critically overlooked psychiatric need.

Actually, I’ve been in contact with a clinical psychologist who has done prior work in an office that offers it. This isn't something I decided to do upon waking up this morning. It’s been a while in the back of my mind.

 

[JacobMcCandles]

I'm jealous you feel like you can open a ketamine clinic and look yourself in the mirror every morning.

 

[EctopicFetus]

Outside of the moral quandry, I would look at others who did this online. It’s not rocket science. Are you worried about he business side? The medical side? I’ll say this market seems to be insanely saturated near me. I looked at this maybe in 2018, morally it wasnt for me. I also felt that this business has 0 barrier to entry (which is what happened here locally) and I have seen it offered by urgent cares near me.

So ask yourself beyond the moral question how will i do this better than someone else? It can be as simple as marketing, PCP relationships etc. Few ED docs have that at a scale that matters. Maybe the psych people will refer to you but that will dry up as soon as an anesthesiologist decides to do this.. Again, i dont know you or the specifics of your market but all this should be considered.

High margin, low barrier to entry stuff will get filled quickly and IMO you have to be better than everyone even if you have the first mover advantage. In addition, IN ketamine is here, etc etc.

I think if you do this find adjuncts. If your morals sink low enough you could do an “infusion” clinic and do IVs for healthy people with random vitamins and take care of hung over people as well. If I wanted out I would do IV hydration as well as weight loss clinic.

I think you could easily get 50+ “clients” doing medical weight loss at 1k a month and your costs would be quite low. Don’t ask me why but I have mentally gone through this whole thing. Re the weight loss i would do it like this.

1) 1k a month, includes monthly check ins in person or virtual (pt preference), check labs, weight in and do a 20-30 min visit to discussion nutrition as well as excercise.
2) you provide all the meds. I will admit i didnt look into the legal side of this but you could contract with a compounding pharmacy or you can buy the stuff yourself and dispense. Or if legal buy the high dose Wegovy etc and reallocate it.
3) you have built in customers for B12 shots and other nonsense people may or may not need.

There is more to think through but I am confident this could easily get you $500/pt per month in profit (likely more) which is 25K a month for 25 hours a month of patient time (30 mins per patient) PLUS some extra time MINUS people who wont do their meetings. Again, plenty of adjunct ways to make money but some food for thought.. IMO this serves a more real purpose than Ketamine.

Plenty of data out there that weight loss is really good using these drugs plus extra benefits from the weight loss PLUS IMO it is important to do it right. At a minimum you can mentally justify that you are helping people more so than ketamine but might be my own bias.

I also think it would be pretty easy to get to 100+ patients if you hit the marketing right.

 

[RustedFox]

Actually, I’ve been in contact with a clinical psychologist who has done prior work in an office that offers it. This isn't something I decided to do upon waking up this morning. It’s been a while in the back of my mind.

None of this changes anything that I've said.

 

[emergentmd]

Owning a business is GREAT. Be your own boss. Suck it up, build up some $$$$, and start slow. Always keep your ER job and working less makes it easier. You are young, have time, make alot of $$$$. No reason to rush.

 

[funnybanana]

None of this changes anything that I've said.

That’s awesome. Thank you for your input.

 

[funnybanana]

Outside of the moral quandry, I would look at others who did this online. It’s not rocket science. Are you worried about he business side? The medical side? I’ll say this market seems to be insanely saturated near me. I looked at this maybe in 2018, morally it wasnt for me. I also felt that this business has 0 barrier to entry (which is what happened here locally) and I have seen it offered by urgent cares near me.

So ask yourself beyond the moral question how will i do this better than someone else? It can be as simple as marketing, PCP relationships etc. Few ED docs have that at a scale that matters. Maybe the psych people will refer to you but that will dry up as soon as an anesthesiologist decides to do this.. Again, i dont know you or the specifics of your market but all this should be considered.

High margin, low barrier to entry stuff will get filled quickly and IMO you have to be better than everyone even if you have the first mover advantage. In addition, IN ketamine is here, etc etc.

I think if you do this find adjuncts. If your morals sink low enough you could do an “infusion” clinic and do IVs for healthy people with random vitamins and take care of hung over people as well. If I wanted out I would do IV hydration as well as weight loss clinic.

I think you could easily get 50+ “clients” doing medical weight loss at 1k a month and your costs would be quite low. Don’t ask me why but I have mentally gone through this whole thing. Re the weight loss i would do it like this.

1) 1k a month, includes monthly check ins in person or virtual (pt preference), check labs, weight in and do a 20-30 min visit to discussion nutrition as well as excercise.
2) you provide all the meds. I will admit i didnt look into the legal side of this but you could contract with a compounding pharmacy or you can buy the stuff yourself and dispense. Or if legal buy the high dose Wegovy etc and reallocate it.
3) you have built in customers for B12 shots and other nonsense people may or may not need.

There is more to think through but I am confident this could easily get you $500/pt per month in profit (likely more) which is 25K a month for 25 hours a month of patient time (30 mins per patient) PLUS some extra time MINUS people who wont do their meetings. Again, plenty of adjunct ways to make money but some food for thought.. IMO this serves a more real purpose than Ketamine.

Plenty of data out there that weight loss is really good using these drugs plus extra benefits from the weight loss PLUS IMO it is important to do it right. At a minimum you can mentally justify that you are helping people more so than ketamine but might be my own bias.

I also think it would be pretty easy to get to 100+ patients if you hit the marketing right.

Thank you for the nice response. I’m going to look into it much deeper.

 

[emergentmd]

Short of cheating or breaking the law, I don't judge what business if moral or not. But I strongly suggest you keep your job. Make your 4-500K/yr, save money, and open a business without taking out a big loan. This allows you to take it slowly, reduce the risks, keep a high paying income, and reduce the financial stress of running a business.

When you have a big loan to service and no other income, it makes for hastened decisions.

 

[WhatJobDoIPick]

Short of cheating or breaking the law, I don't judge what business if moral or not. But I strongly suggest you keep your job. Make your 4-500K/yr, save money, and open a business without taking out a big loan. This allows you to take it slowly, reduce the risks, keep a high paying income, and reduce the financial stress of running a business.

When you have a big loan to service and no other income, it makes for hastened decisions.

Not sure "make money no matter what" is a great life goal.

Ketamine, IV infusion, weight loss clinic, liposuction, Botox, whatever. You're just using your degree and license to be a snake oil salesman. You might as well have become an NP

 

[emergentmd]

Who is to judge how someone makes money. If it is legal, not immoral then what is the big deal?? Everyone needs to make money. If he opens a business that has adds zero value to society, but doesn't hurt anyone then what is the issue?

If he can find sticks on the road and make a living out of it, go ahead.

 

[WhatJobDoIPick]

Who is to judge how someone makes money. If it is legal, not immoral then what is the big deal?? Everyone needs to make money. If he opens a business that has adds zero value to society, but doesn't hurt anyone then what is the issue?

If he can find sticks on the road and make a living out of it, go ahead.

I guess some people take issue with using your degree and license for such applications.

We also took an oath, if you care about that.

 

[HoosierdaddyO]

I guess some people take issue with using your degree and license for such applications.

We also took an oath, if you care about that.

So does this oath apply to the same physicians when it comes to late term non emergent abortions or chemically castrating confused preteens! I mean I’m all for doing the right thing here… but if the guy wants to make a buck using his medical license and isn’t harming anyone… who are you to pass judgement 🤷‍♂️. No offense of course, just not a fan of this level of moral superiority because of our medical degree. Lawyers take a similar oath and some of the sleaziest people I know are well renowned in that profession, ie politicians lol.

 

[RustedFox]

Would you like ketamine for any reason?
Ok.

Sounds like drug dealing to me.

 

[TooMuchResearch]

Not sure "make money no matter what" is a great life goal.

Ketamine, IV infusion, weight loss clinic, liposuction, Botox, whatever. You're just using your degree and license to be a snake oil salesman. You might as well have become an NP

That's roughly 70% of my job already.

 

[sloh]

Not sure "make money no matter what" is a great life goal.

Ketamine, IV infusion, weight loss clinic, liposuction, Botox, whatever. You're just using your degree and license to be a snake oil salesman. You might as well have become an NP

Tbf Botox does work well

 

[HemorrhagicShock]

Also opening a Ketamine clinic isn't the easy cash cow you think it is.

It's fraught with competition, low margins, and 80% of the Ketamine Clinic business is marketing/lead generation/customer acquisition (which is MUCH more challenging than it sounds, and you as a physician have zero expertise in this, but all the delusion that you think you can do it better than people who have been doing it for years)

I encourage you to go into it purely as an exercise of how challenging running a standalone ketamine clinic can be.

 

[throway134]

I guess some people take issue with using your degree and license for such applications.

We also took an oath, if you care about that.

Personally I think it depends on how they’re running it. Indiscriminately giving ketamine to everyone who walks in the door? Of course that’s bs and we should stomp on it.

Giving ketamine for indications based on weak or emerging literature? Solid moral gray zone to me. Wouldnt do it personally, but I won’t hate anyone for doing this, might look at em a little funny.

I would much rather have a md doing lipo, Botox etc than an np because they are more likely to be discriminatory/have boundaries in who they attempt it on.

Anyone who is doing this indiscriminately or with inadequate follow up (e.g. advertising across state lines, doing a surgical procedure and then sending home with drains on fixed wing aircraft and “Ed follow up”) can burn in hell.

 

[dozitgetchahi]

Jeez.
Not a thought given to "is this the right thing to do", huh?

Ketamine for all!

Mom doesn't want to mom because it's not all Instagram moments and live-laugh-love? Ketamine.

Mad at your coworkers? Ketamine.

Bummed because your sportsball team lost? Ketamine.

That's the business model. No, I'm not going to buy it that you're out there providing a critically overlooked psychiatric need.

Sing it to the tune of Eric Clapton’s “Cocaine”, and you’ve got it

 

[Tiger26]

No intention to do this myself, but it's a little disenguous to act as if much of emergency medicine isn't unnecessary snake-oil medicine and needless reassurance.

 

[Psychiater]

Cool. I'll just leave psychiatry and staff an emergency department. wtaf

 

[JacobMcCandles]

Personally I think it depends on how they’re running it. Indiscriminately giving ketamine to everyone who walks in the door? Of course that’s bs and we should stomp on it.

Giving ketamine for indications based on weak or emerging literature? Solid moral gray zone to me. Wouldnt do it personally, but I won’t hate anyone for doing this, might look at em a little funny.

I would much rather have a md doing lipo, Botox etc than an np because they are more likely to be discriminatory/have boundaries in who they attempt it on.

Anyone who is doing this indiscriminately or with inadequate follow up (e.g. advertising across state lines, doing a surgical procedure and then sending home with drains on fixed wing aircraft and “Ed follow up”) can burn in hell.

How do you think most are running it? How many people do you think bariatric surgery centers are turning away? How many people do you think cosmetic procedure clinics are turning away? My experience is that if they can pay for it, they'll get it.

 

[emergentmd]

If you are running a Ketamine clinic and have some medical basis without harm then I don't see how this is any different than many fields I can name.

Plastic surgeons and all the boob jobs.
Dermatologist and all their Fillers/lasers
FM and weight loss clinic
Pain management

I can go on and on.


All of the stone throwers, next time don't order that CT head or Abd when you know it is going to be negative. All those pts with URI, don't give abx. In reality, if we all are practicing pure medicine, then 80% of pts should get an MSE and sent to UC b/c they surely do not need ER care.


I can't stand docs standing behind their oath like they are some superior field when they are no different than the average man.

 

[JacobMcCandles]

All of the stone throwers, next time don't order that CT head or Abd when you know it is going to be negative. All those pts with URI, don't give abx. In reality, if we all are practicing pure medicine, then 80% of pts should get an MSE and sent to UC b/c they surely do not need ER care.


I can't stand docs standing behind their oath like they are some superior field when they are no different than the average man.

There’s quite a bit of difference between practicing in the pit and operating a ketamine cash clinic but you know that.

 

[emergentmd]

If nothing is immoral or illegal, then no one should be the jury on what is ethical. Just because you would not doesn’t mean someone who does is wrong.

But u already know that.

 

[RustedFox]

No intention to do this myself, but it's a little disenguous to act as if much of emergency medicine isn't unnecessary snake-oil medicine and needless reassurance.

There's a difference between the unnecessary Z-pak/steroid taper and the unnecessary Ket-trip-on-demand for cash.

 

[Tiger26]

There's a difference between the unnecessary Z-pak/steroid taper and the unnecessary Ket-trip-on-demand for cash.

But is it? Antibiotics have unnecessary complications too? Like how much what what we do in the ED is really necessary?

 

[VA Hopeful Dr]

But is it? Antibiotics have unnecessary complications too? Like how much what what we do in the ED is really necessary?

Yes it is. I do those things to avoid patient complaints and keep my job where I'm able to help at least most of my patients. Same with you guys. You give the antibiotics to get the cough and cold people out of the ED so that you're available for all the stuff that actually requires your expertise.

 

[JacobMcCandles]

But is it? Antibiotics have unnecessary complications too? Like how much what what we do in the ED is really necessary?

Does the patient hand you cash for prescribing that z-pack?

 

[RustedFox]

But is it? Antibiotics have unnecessary complications too? Like how much what what we do in the ED is really necessary?

Z pack versus Ketamine?!

Bruh .

 

[Tiger26]

Yes it is. I do those things to avoid patient complaints and keep my job where I'm able to help at least most of my patients. Same with you guys. You give the antibiotics to get the cough and cold people out of the ED so that you're available for all the stuff that actually requires your expertise.

So you're saying that you give unnecessary drugs out to avoid patient complaints....

Yup totally different.

What I'm saying is to tone down the virtue signaling. So much of emergency medicine is totally unnecessary (although the fault lies broadly among stake holders across society and the health care system).

But how many unnecessary things do we order:
-CTs we know will be negative yet could cause cancer
-Antibiotics that are not indicated yet could cause resistance and c diff
-Trauma activations that don't change anything yet result in a huge bill to the patient
-CMG up-charging like signing all APP charts

I have no desire to start a ketamine clinic (or anything else similar) but let's be mindful of throwing stones when we live in a house of medicine increasingly built with ever more glass.

 

[emergentmd]

There are a lot of holier than thou virtual signaling here.

Look at all the ozempic clinics opening. Med spas. Vitamin infusions.

We live in a capitalistic free market society. Some of you sound like socialist nuts. “Do as I say bc I know better”

 

[VA Hopeful Dr]

So you're saying that you give unnecessary drugs out to avoid patient complaints....

Yup totally different.

What I'm saying is to tone down the virtue signaling. So much of emergency medicine is totally unnecessary (although the fault lies broadly among stake holders across society and the health care system).

But how many unnecessary things do we order:
-CTs we know will be negative yet could cause cancer
-Antibiotics that are not indicated yet could cause resistance and c diff
-Trauma activations that don't change anything yet result in a huge bill to the patient
-CMG up-charging like signing all APP charts

I have no desire to start a ketamine clinic (or anything else similar) but let's be mindful of throwing stones when we live in a house of medicine increasingly built with ever more glass.

It in fact is. I'm not basing my entire practice on things outside the mainstream of medicine.

I used to be very strict with antibiotics. Cost me 2 different jobs. Now with adults, I just don't care. They want an antibiotic, I'll do it (luckily doxy isn't really associated with c diff and is old enough with minimal resistance that I think it'll be OK). The other 25ish patients I see that day are regular PCP stuff.

Your other examples are EM specific so I'll leave them alone.

 

[VA Hopeful Dr]

There are a lot of holier than thou virtual signaling here.

Look at all the ozempic clinics opening. Med spas. Vitamin infusions.

We live in a capitalistic free market society. Some of you sound like socialist nuts. “Do as I say bc I know better”

Ozempic is approved for weight loss.

 

[HoosierdaddyO]

Ozempic is approved for weight loss.

What’s your point? Marijuana use to place you in the slammer and an appearance before court and now it’s a known entity amongst pain specialists.

Just sounds like you all are a bunch of salty docs who are so mad at yourselves for being stuck in the hamster wheel. If he opens up a ketamine clinic what’s it to you? Like literally how does that have any effect on you and your practice. Everyone enough of this self righteous look at me I’m a doctor attitude. It’s rather off putting.

If you don’t like the business plan or disagree with the medical necessity for a ketamine clinic… fine! I probably even agree with you! But the “ohhh no doctors shouldn’t do that”… wake up and smell the napalm. He ain’t doing anything illegal or unethical, and if he did… well the state would pull his license and they ain’t!!!!

 

[Apollyon]

(luckily doxy isn't really associated with c diff

Photodermatitis, dude!

 

[PB2464]

Looking for advice here. In short, couple years out of residency and hate it. I have zero debt and want to leave this specialty for good. It’s not the actual emergency care—which I think most of us love— but all the other bull**** that comes with it.

I have great bedside manner. I am hard working and feel that I can better use my talents starting my own business.

To any of those who have started a ketamine clinic, can you offer any insight on how to get started?

Just cut your hours to PT before leaving. Do locums. I guarantee you'll feel better than working FT. Just walking away this early is a huge mistake.

 

[emergentmd]

Rules/Regulations and Capital availabilities are weighted greatly against doctors leaving the ability to run/own their own business increasingly difficult and many times impossible. Single doc and small group practices are becoming economically impossible. Hospitals and VC backed companies are buying up practices and we are left with essentially the cash pay/boutique practices.

A doc wants to open/own a medical practice that breaks no rules and legal then some of our OWN tells him/her that it is unethical? How outrageous keeping a doc down when we should root for them.

If Ketamine clinics are money makers, you will see VC come in and open them up making the docs work as hourly workers making $$$ for them.

Docs on this board constantly complain that EM is dying, corporate takeover of medicine, VC/Hospitals skimming profit off our hard work getting burned out working in the PIT. Docs asking for suggestions on how to get out of the PIT all the time on this board. But now when a doc has a lane to own something legal and get out of the PIT, the same docs complaining (I'm looking at you Hemorrhagic Shock/Mount/Rusted) constantly about this Job/EM push back that it is not ethical?

Ridiculous. Continue working in the PIT and complaining how miserable your job is while I cheer on FunnyBanana to take control of his life.

 

[HoosierdaddyO]

Rules/Regulations and Capital availabilities are weighted greatly against doctors leaving the ability to run/own their own business increasingly difficult and many times impossible. Single doc and small group practices are becoming economically impossible. Hospitals and VC backed companies are buying up practices and we are left with essentially the cash pay/boutique practices.

A doc wants to open/own a medical practice that breaks no rules and legal then some of our OWN tells him/her that it is unethical? How outrageous keeping a doc down when we should root for them.

If Ketamine clinics are money makers, you will see VC come in and open them up making the docs work as hourly workers making $$$ for them.

Docs on this board constantly complain that EM is dying, corporate takeover of medicine, VC/Hospitals skimming profit off our hard work getting burned out working in the PIT. Docs asking for suggestions on how to get out of the PIT all the time on this board. But now when a doc has a lane to own something legal and get out of the PIT, the same docs complaining (I'm looking at you Hemorrhagic Shock/Mount/Rusted) constantly about this Job/EM push back that it is not ethical?

Ridiculous. Continue working in the PIT and complaining how miserable your job is while I cheer on FunnyBanana to take control of his life.

Cough* Amen Cough*.

 

[Birdstrike]

We did some IV ketamine treatment in my Pain fellowship. While it might have some utility in certain situations, overall I wasn’t impressed.

 

[emergentmd]

Jeez.
Not a thought given to "is this the right thing to do", huh?

Ozempic for all!

Mom doesn't fit the size criteria because it's not all Instagram moments and live-laugh-love? Ozempic.

Mad at your coworkers because hey are all thinning out? Ozempic.

Bummed because your size 4 and not 2? Ozempic.

That's the business model for most clinics. No, I'm not going to buy it that you're out there providing a critically overlooked Obesity need.

Fify

 

[emergentmd]

BTW, OP said he wanted to open a wellness/ketamine and the detractors are making it seem all he is doing is putting IVs in pushing ketamine.

I have an ER doc that opened a wellness/Fitness practice (No Ketamine) cash pay that is successful. He is leaving EM doing this full time 9-5 job.

 

[RustedFox]

Fify

Although your retort is clever; I don't agree with that practice either.

The correct answer in that situation is not: "I took ozempic shots and lost weight", but rather - "I changed everything about my life and my own arm brought about the victory which will last for a lifetime."

They don't need Ozempic, they need a gym membership.

It's amazing what fitness and a proper mindset will do for a human. Sad about your weight? Get buff. You won't need Ozempic OR ketamine.

"The iron never lies."

I prescribe iron for both weight loss and depression. 45 pound discs. Amazing what it will do.

 

[emergentmd]

Although your retort is clever; I don't agree with that practice either.

The correct answer in that situation is not: "I took ozempic shots and lost weight", but rather - "I changed everything about my life and my own arm brought about the victory which will last for a lifetime."

They don't need Ozempic, they need a gym membership.

It's amazing what fitness and a proper mindset will do for a human. Sad about your weight? Get buff. You won't need Ozempic OR ketamine.

"The iron never lies."

I prescribe iron for both weight loss and depression. 45 pound discs. Amazing what it will do.

Im just messing with you. Ozempic has a place for the morbidly obese where the benefits greatly outweigh the side effects.

BUT Ozempic has turned into the "lets lose 10-20lbs" drug that I see alot of our nurses use it for. There are pop up online clinics that will throw a script at anyone willing to pay $100 and then they get it on the cheap through some dark web/online/china shipped place.

Lets not fool ourselves that most of these clinics have little medical value and are essentially cash for script mills.

 

[beebermd]

Not sure "make money no matter what" is a great life goal.

Ketamine, IV infusion, weight loss clinic, liposuction, Botox, whatever. You're just using your degree and license to be a snake oil salesman. You might as well have become an NP

lol. in my office, I do literally every one of these services and I have never heard of botox and liposuction called snake oil. As an ER physician who spent 2 years training in liposuction to specifically have an out from the ER life, I am not sure you appreciate its complexities. I assure you it is not easy, and it is def not snake oil.

there is literature out there for ketamine therapy. I do it I even coordinate care with psych docs.
there is literature out there for GLPs. I do them.
there is literature out there for HRT. I do it

my office is cash only. Obviously, there is a financial benefit. But the real value is the fact that I have free reign to do what i feel is right for my patients. I absolutely love the fact that I can do my own research, use my own medical judgment, and treat patients without insurance companies, CMGS, HCA or any one else (in accordance with state laws) dictating what I can or cant treat and in what manner I must do so.

With this freedom also comes the potential for bad actors and there are many, dont get me wrong. But to pigeon hole the entire space, when there is obvious utility just seems a bit short sighted.

we are opening 12 additional sites this year. In the last 3 years in the ER, I have gone from 12 shifts/mth, to 8 to 6 and im pure locum starting in jan. I will never have to work another night holiday or weekend unless I want to.

Every day, docs here are asking how to get out of the ER, yet the vast majority wont think outside the box, or will trash the ones that do. Its a pretty simple formula: Continue to work the ER....use that money to fund something else..... scale back ED shifts as the new income replaces the ED income.... Be your own boss and live on your own terms......and if you decide to get into an area that is full of "snake oil" salesman......THEN DO IN WHATEVER WAY MAKES YOUR MORAL COMPASS POINT NORTH.......there is nothing that says you have to do it like them and if you end up like them then you have no one to blame but yourself.

 

[RustedFox]

Im just messing with you. Ozempic has a place for the morbidly obese where the benefits greatly outweigh the side effects.

BUT Ozempic has turned into the "lets lose 10-20lbs" drug that I see alot of our nurses use it for. There are pop up online clinics that will throw a script at anyone willing to pay $100 and then they get it on the cheap through some dark web/online/china shipped place.

Lets not fool ourselves that most of these clinics have little medical value and are essentially cash for script mills.

Yep. So if you're gonna open a "wellness/ketamine clinic", where do you think 99%+ of that business-sustaining revenue is gonna come from?

Ketamine has it's role in treatment-resistant depression for those who have failed other options after *an honest try*.

We joke about how the COPD'ers have a cigarette in one hand and their Albuterol neb in the other, taking hits off of both in sequence.

Same with the Ozempic/Ket discussion.
Cheesecake in one hand, Ozempic pen on the other.
Depression machine (cellphone and an unREAL view of life) in one hand, Ketamine nasal spray in the other.

People can say that I'm hypercritical of a lot of things; and they're not wrong - but no way did I get an MD to be a drug dealer or create the next Albuterol/Cigarette situation.

There's tangential stuff that I'd love to rant on (stop collecting superhero plastic garbage, men... Go DO superhero stuff with your life instead of fanboying over the next garbage Marvel movie extended director's special edition cut with outtakes). Stop CONSOOMing.

The common thread behind it all is a loss of honesty about the desire for self betterment. People say they want to "be better", but won't do what it takes because it's t o o h a r d.

Discipline equals freedom.

 

[VA Hopeful Dr]

What’s your point? Marijuana use to place you in the slammer and an appearance before court and now it’s a known entity amongst pain specialists.

Just sounds like you all are a bunch of salty docs who are so mad at yourselves for being stuck in the hamster wheel. If he opens up a ketamine clinic what’s it to you? Like literally how does that have any effect on you and your practice. Everyone enough of this self righteous look at me I’m a doctor attitude. It’s rather off putting.

If you don’t like the business plan or disagree with the medical necessity for a ketamine clinic… fine! I probably even agree with you! But the “ohhh no doctors shouldn’t do that”… wake up and smell the napalm. He ain’t doing anything illegal or unethical, and if he did… well the state would pull his license and they ain’t!!!!

The data for marijuana in chronic pain sucks. Head over to the pain forum and see what they're saying about it.

I'm actually very happy with my job, thanks for asking.

I care for many reasons, most of which I feel like have been said in this forum before when this comes up but I'll be glad to list them again:

Shyster doctors actually do make my life worse. "Men's wellness clinics" put my patients on totally inappropriate testosterone regimens and then when the patient gets tired of paying cash for that comes to me demanding I write for the same regimen.

Same with holistic places. I have heard many times "I'm not going to treat my <insert chronic disease here> with medicine I'm going to do <insert nonsense that some shyster says is better>", meanwhile their A1c never goes below 14.

In truth the purely ketamine places don't bother me. I've actually sent patients to them in the past since psychiatry takes 6+ months here. But it's almost never just ketamine since by itself that isn't profitable, it ends up expanding into the other areas of wellness which then causes me some of the issues I listed above.

 

[PB2464]

lol. in my office, I do literally every one of these services and I have never heard of botox and liposuction called snake oil. As an ER physician who spent 2 years training in liposuction to specifically have an out from the ER life, I am not sure you appreciate its complexities. I assure you it is not easy, and it is def not snake oil.

there is literature out there for ketamine therapy. I do it I even coordinate care with psych docs.
there is literature out there for GLPs. I do them.
there is literature out there for HRT. I do it

my office is cash only. Obviously, there is a financial benefit. But the real value is the fact that I have free reign to do what i feel is right for my patients. I absolutely love the fact that I can do my own research, use my own medical judgment, and treat patients without insurance companies, CMGS, HCA or any one else (in accordance with state laws) dictating what I can or cant treat and in what manner I must do so.

With this freedom also comes the potential for bad actors and there are many, dont get me wrong. But to pigeon hole the entire space, when there is obvious utility just seems a bit short sighted.

we are opening 12 additional sites this year. In the last 3 years in the ER, I have gone from 12 shifts/mth, to 8 to 6 and im pure locum starting in jan. I will never have to work another night holiday or weekend unless I want to.

Every day, docs here are asking how to get out of the ER, yet the vast majority wont think outside the box, or will trash the ones that do. Its a pretty simple formula: Continue to work the ER....use that money to fund something else..... scale back ED shifts as the new income replaces the ED income.... Be your own boss and live on your own terms......and if you decide to get into an area that is full of "snake oil" salesman......THEN DO IN WHATEVER WAY MAKES YOUR MORAL COMPASS POINT NORTH.......there is nothing that says you have to do it like them and if you end up like them then you have no one to blame but yourself.

Wait, so the debate is on the morality of ketamine and then you come in here saying you do Botox and lipo? I'm not sure how convincing that is.

 

[JacobMcCandles]

Moral and ethical issues aside, I don’t think an EM doc has the appropriate training to determine who does/does not meet the qualifications for ketamine. I also don’t think EM docs should be on the forefront of treatments that are out of their wheelhouse.